More information is becoming available every day regarding post-COVID-19 conditions (PCC), known more commonly as long COVID. Long COVID is an often debilitating illness that occurs in at least 10% of victims of COVID-19. To date, more than 200 symptoms have been identified that affect multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily. While it is more severe and more common in patients who were hospitalized or unvaccinated, it has also been described in those with mild disease or even in asymptomatic individuals.
The incidence of long COVID in children is significant. In a recent conversation I had with a pediatrician, she noted that since the pandemic, her office has become packed with children with poorly defined symptoms. It is difficult to know if these symptoms are malingering, long COVID, or a mild illness that would not necessarily warrant a visit to a physician. However, she said, it all takes time to try to work it out, and every complaint must be taken as serious.
Typically, a child might complain of headache or fatigue, especially after exercise. It would not be unusual for a school nurse to conclude that the child simply does not want to participate in such activities, because especially after rest, symptoms may subside, only to recur with exercise. Indeed, many diverse symptoms may exist even in the face of normal laboratory test results.
The cause of long COVID is far from clear. Experts have debated whether it is due to residual viral elements, or an inflammatory response to leukotrienes or cytokines, or a combination of both. As such, there is no treatment other than rest and symptomatic management.
Thus, long COVID presenting as a diagnosis may make not only the school nurse's job even harder, but also that of all professionals involved in pain management settings. For example, regarding school nurses and indeed all nurses and physicians, the questions to address are:
1. Are these professionals trained in long COVID diagnosis? and
2. Should these health professionals document vaccination or exposure to COVID?
Many younger children may have been exposed and/or not vaccinated and even had COVID, disguised as an upper respiratory infection. Basic guidance dictates that all complaints must be heard and the health care professional must indicate that the patient is believed.
Further information may be obtained from the US Centers for Disease Control and Prevention, the Veterans Administration, and the American Academy of Physical Medicine and Rehabilitation.
References